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Adventures In The Mental Health Trade, Part One

May 26, 2011


Many years ago, I worked for a local Community Mental Health Center as what is called a “Master’s level clinician” meaning I  had a master’s degree in psychology and counseling and did psychotherapy and counseling.  I was  contracted out half-time to provide psychological services (eligibility validation testing,  consultation, individual and group therapy) to what was called an Intermediate Care Facility for the Mentally Retarded, or ICF/MR for  short.

The facility was actually one wing of a nursing home, housing 36 adult residents whose medical problems and/or behavior problems kept them from being placed in the community in a group home or supervised apartment setting.  Many had poorly controlled seizure disorders. Others were brittle diabetics.  Four had Prader-Willi Syndrome.  Others had explosive temper outbursts, schizophrenia, depression, or another psychiatric disorder.

The nursing home was owned by ARA,  a giant corporation whose spokesmen bragged about being the “largest non-financial corporation in  America,” and  claimed to  own several chains of nursing homes and holdings  ranging from landmark buildings in downtown Los Angeles to the beer concession at Mile High Stadium in Denver.

Upon interview, they weren’t sure I measured up to their exacting standards of professional excellence and expertise, their cutting-edge Standards of Practice, and the impeccable  ethical standards they demanded.  True, I had   adequate credentials and very good  references, and had special training in A, B, and C….ah, but not in D! ” You’ve had training in eight sub-specialties but not  in nine.” They harrumphed,  worried, expressed concerns and doubts, and generally   acted like the fact they were agents of a rich corporation made them experts on professional ethics and practices. Since they were eager to save money by hiring someone with only a master’s degree instead of a Ph.D., and I was the only clinician at the regional mental health center with any experience in working with mentally retarded adults, they eventually sighed and decided I would do.

The first work assignment they gave me was to invent fake Medicaid records for services not rendered and backdate them to as much as four months before I started working there. It seems there had been a four-month gap between my predecessor’s last day and my first day. Medicaid billing had continued even when the services being billed for had long stopped. When I said, “I can’t do that,” they acted like I was a slacker, trying to evade the work I was hired to do.  After all, since they are paying me I’m supposed to be a compliant flunky. Isn’t that  what  “professionalism” is all about?  Being a dutiful subordinate who does what he’s told?  I explained, calmly and politely, that falsification of Medicaid records was clearly  illegal ( a federal crime) as well as  very unethical and therefore I could not and would not do it.  They understood  what I was saying, every word of it . You might say they “understood the words but not the music.” They were very frustrated with me and mumbled to others about my “attitude” and hinted I was “not a team player.”

I explained these developments to my “real” boss (the one whose signature actually appeared on my paychecks), the Executive Director of the Mental Health Center.  “That’s outrageous,” he said. “Of course you can’t do that. That would be unethical as hell!”  I felt reassured and, as they say, supported. But as I was leaving his office, hand on the doorknob, he added, “Don’t blow the contract with them!  We need  that contract and the money it brings us.”

I felt I’d  been given mixed messages: refuse their orders but don’t alienate them.  Defy them but keep them happy.  I suppose what I did was the best compromise I could muster under the competing demands of my two employers.  I wasn’t proud of myself for doing i t but I became passive-aggressive.

ARA bosses would say, “We really need those gaps in our Medicaid records filled. We need you to do that!”  And I would say, “Gee, I’m really busy this week. I’ve got to do testing on Nellie and Frankie,   we’ve got  IHPs (Individual Habilitation Plans)on three others, and then there’s that in-service on Friday I have to prepare for.  I don’t think I’ll  have time to get to those this week…”

The next week we would d o the same dance, play the same game,  each sing the same song.  Since they stopped just short of giving me a direct order, I could stop short of giving them a blunt refusal.  (“Whew!, I’m booked up this week.  Next week? Let’s see….hmmm… I’m afraid that  doesn’t look much better.”). They eventually got the message: that I had no intention of ever doing it.  Since “it” was something they knew as well as I that it was  unprofessional, unethical,  and illegal,they couldn’t come out in the open and bluntly demand it.

Some months later,  the local newspaper published a story about mighty parent company  being indicted in federal court for Medicaid fraud.  Allegedly they had engaged in a takeover of another chain of nursing homes and billed the costs of the corporate takeover to Medicaid as a  “medical expense”. When the Medicaid auditors realized this, federal charges resulted. The immediate consequence was a  mandatory general meeting of all  staff in which we were assured there was “no allegation of wrongdoing” ( a transparent  lie) and  that is was  “all just a misunderstanding about allowable tax deductions” (another lie) and that  all of  us should stick together as one big happy family and close ranks against  those evil “outsiders” who don’t understand “how we do things  here.”

That’s the least of it. I have more to say about my experience with this organization, but as the Irish say “sin sceal eile”  which means “that’s another story,” for another day.

P.S.  I’m not sure what happened to ARA. I heard they sold off their nursing homes.  I’m not sure they still exist. Someone told me that ARA, like the shadowy Blackwater Corporation, has changed its name over the years apparently to keep one step ahead of its  reputation for deceit and sleaze.  Perhaps it merged with another corporation or was itself swallowed up and ceased to exist as a  corporate entity.  

I marvel at the continuing presumption many people have that big organizations are the standard-bearers of ethics, upholders of standards of practice, and that therefore  only their subordinate employees,  on an individual basis, are ever unethical practitioners.

In the mental health “industry” (as it is often called), it’s not the clients who make the job so difficult and challenging.












3 Comments leave one →
  1. November 11, 2010 8:20 PM

    Great job on maintaining your integrity!!!!!!!

    It seems that the mental health field accepts fraud (of all kinds) as a way of doing business. The indusrty is reaching a crash and burn phase!
    You can read my “story” at

    • donegaldescendant permalink*
      November 12, 2010 7:53 AM

      Thank you. I disagree with the comon pose that corporations and agencies are the guadians of integrity and lack of integrity and ethics is a problem only individuals have.

  2. November 12, 2010 7:59 AM

    IMO…Corporations and agencies act as dysfunctional families do….scapegoating an individual here and there to “take the blame” and support denial for the organizations themselves.
    Yep….could have been you!

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